Inside Health

CASES; Doctor, Please Carve Out the Time to Heal Thyself

By SHANNON GULLIVER, M.D.

Published: June 29, 2010

I was sure it was just acid reflux, or sympathy pains for my patients on the gastrointestinal cancer ward. Or at worst, an ulcer from the stress of being an intern too busy playing doctor to go see one herself.

But the pain in my belly did not stop gnawing when I left the GI cancer ward and moved to the emergency room, and it did not even stop when I went on vacation. Finally I got scoped, from top and bottom: no polyps, no ulcers, no reflux, no tumors.

Instead, the gastroenterologist saw candida (yeast) rising in my esophagus. Candidal esophagitis is easily diagnosed, and treatable with a pill. I knew the disease well -- I had three patients with it at the time I got my diagnosis.

But there was the rub: Candidal esophagitis is a disease of the immunocompromised. My three patients had AIDS; cancer; and vasculitis, an autoimmune disease of the blood vessels. In fact, it's an ''AIDS-defining illness'': a patient found to have esophageal candidiasis is considered H.I.V.-positive until proved otherwise. What was I, a young, healthy doctor, doing with an infection normally found in the seriously ill?

And so the workup began: I spent my days ordering blood tests and CT scans for my patients; I spent my days off getting my blood tested and lying in scanners. While these procedures improved my empathy -- it's true what patients say about IV contrast liquid feeling creepy as it rushes through one's veins and pre-colonoscopy bowel preps being nasty! -- it was challenging to care for patients while being one myself.

Doctors dislike sick doctors. Colleagues too ill to work increase everyone else's workload and make patients uneasy. At first, I did not want to tell anyone at work what was happening to me. But then I started to talk to fellow doctors at other hospitals.

One revealed that she had broken out in shingles, an illness that seldom affects anyone but elderly and immunocompromised patients. Another reported a repulsive fungal infection of the lips called angular cheilitis (No. 1 risk factor: dentures). A third spoke shamefully of his bout with C.difficile, a potentially fatal hospital-acquired diarrheal infection that usually crops up in nursing home residents, AIDS patients and people on long-term antibiotics.

Worst of all was an intern who contracted a rare bug that has been isolated in patients with congenital and fatal pulmonary disease, which rotted a hole in her lung so severe that she required surgical intervention. She died shortly after the surgery, in the very hospital where she worked.

Each of these pathogens exists all around us -- we are swimming in yeast and bacteria and viral particles. Yet most of us do not succumb to them until we are weak, old or severely ill. Why are young doctors falling prey, and why are we afraid to talk about it?

To be sure, we want to be altruists: traipsing fearlessly into the AIDS clinic, the cancer ward, the emergency room. To be sure, we wade through more germs every day on our rounds than the average person does. And to be sure, we keep unhealthy schedules, working 27 hours at a stretch, eating out of vending machines and delaying bathroom breaks for hours. We cultivate an ethos of invincibility.

While we encourage our patients to be open about their stigmatized infections and diagnoses, we keep mum about our own, often waiting to speak up until it's dangerously close to too late. In the last year, I've seen at least 10 residents nearly faint (a sign that buys E.R. patients an admission to the hospital) and keep on working -- ashamed of their momentary lapse, fearful of its consequences for their careers and their colleagues' esteem. I do not know how I caught my esophagitis, and I do not care -- there is not one patient into whose germy room I regret having gone, into whose contagious orifices I regret having probed. There is not one night I wish I would've stayed home to sleep rather than scurrying around the hospital taking care of them. It's a privilege to get to do that. But I do wish I had taken a day or two off, once I was sick, to get to the bottom of it.

So far, I have been fortunate in my workup: H.I.V.-negative, malignancies ruled out, immune deficiency diagnostics pending. My doctors are not quite sure where this opportunistic infection found its window of opportunity into my body, or whether it's gone.

There are fleeting moments when we physicians need to be patients. We would do well by our patients to seize those moments and stay away from their bedsides when we are sick ourselves. There's a saying seasoned doctors pass on to us fledglings about facing emergencies in the hospital: ''First, check your own pulse.'' It's time doctors' actions caught up to their adages.